Pancreatic Cancer: Chemotherapy

What is chemotherapy?

Chemotherapy (chemo) uses anticancer medicines to kill cancer cells. The medicines are made to attack and kill cancer cells, which grow quickly. Some normal cells also grow quickly. Because of this, chemotherapy can also harm those cells. This can cause side effects.

When might chemo be used for pancreatic cancer? 

Chemo is part of the treatment for most people with pancreatic cancer. Your healthcare provider may recommend chemo to treat pancreatic cancer in any of the following situations:

• If you have pancreatic cancer that has not yet spread to distant parts of your body, but it’s not clear that all of the cancer can be removed. You may get chemo (often with radiation) as the first treatment to try to shrink the tumor and make surgery possible. Treatment before surgery is called neoadjuvant therapy. 

• If you have surgery to remove the cancer as your first treatment, you may get chemo (often with radiation) to try to make sure all the cancer cells are killed. This is known as adjuvant chemotherapy.

• Chemo is often part of treatment if you have cancer that cannot be removed with surgery, or if you are not healthy enough for surgery.

How is chemo given for pancreatic cancer?

Before treatment starts, you’ll meet with a medical oncologist. This is a doctor who specializes in treating cancer with medicines such as chemo. The doctor will discuss your treatment options with you and explain what you might expect. 

Depending on the specific chemo medicine you’re taking, you may get them in one of these ways: 

• Intravenous (IV). The medicine is given through a small needle that has been put into a vein. The medicine may drip in slowly over several hours or even days, or it may be given more quickly over a few minutes. When chemo is given over days, people often go home with a small infusion pump (a bag that looks like a waist pack) that’s disconnected later.

• Oral. You swallow these medicines as pills.

Chemo is usually given in an outpatient setting. That means that you get it at a hospital, clinic, or healthcare provider's office, and you can go home after the treatment. Less often, you may need to stay in the hospital during treatment. Your healthcare provider will watch you for reactions during your treatments. Since each of your chemo treatments may last for a while, you may want to take along something that is comforting to you, such as music to listen to. You may also want to bring something to keep you busy, such as a book or mobile device.

To reduce the damage to healthy cells and to give them a chance to recover, chemo is given in cycles. Each cycle consists of one or more days of treatment, followed by some time to rest. Cycles normally last three or four weeks. Most people get four to six cycles as part of their initial treatment, which usually lasts for several months. Your healthcare provider will talk about your schedule with you.

What chemo medicines are used to treat pancreatic cancer?

These are some common chemo medicines used to treat pancreatic cancer:

• Albumin-bound paclitaxel (nab-paclitaxel)

• Capecitabine

• Cisplatin

• Docetaxel

• 5-fluorouracil (5-FU)

• Gemcitabine

• Irinotecan

• Irinotecan liposome

• Oxaliplatin

• Paclitaxel

Two or more of these medicines are often combined as the first treatment. Sometimes the chemo medicine gemcitabine is combined with the targeted therapy medicine erlotinib. People who are not healthy enough to get two medicines or people who have already gotten chemo may only receive one medicine.  

What are common side effects of chemo?

Side effects of chemo are different for everyone. They vary based on the medicines you receive. Below is a list of the some of the most common side effects from chemo. Ask your healthcare provider what side effects to watch for.

Hair loss

If you have hair loss, the hair will often grow back after the treatment stops.

Nausea and vomiting

This side effect can often be controlled with medicines. Ask your healthcare provider about it.

Mouth sores

Chemo can sometimes cause mouth sores. This might make it hard for you to eat or swallow. It's important to keep your mouth very clean and avoid foods and substances that could irritate your mouth.

Diarrhea

If you have diarrhea, take antidiarrheal medicines as prescribed by your healthcare provider. You may also need to make changes in your diet.

Loss of appetite or changes in the way things taste

Talk to your healthcare provider if you find you’re having trouble eating or are losing weight. There are often ways to help.

Increased risk of infection

During your chemo treatments, your white blood cell count may become low. This means your immune system won’t be working as well as it normally does. It’s a good idea for you to avoid people who have illnesses that you could catch. It’s also a good idea to take extra safety measures against cuts and scrapes that could become infected. Your healthcare provider will check your blood counts regularly during your treatment. Let your healthcare provider know if you have any signs of an infection. Symptoms include fever, sore throat, a new cough, or burning during urination.

Bleeding and bruising more easily

Chemo can also lower your blood platelet counts. Platelets are needed to help the blood clot well. 

Fatigue

You may feel tired while getting chemo. This normally goes away once treatment ends. 

Some other side effects can also be seen with certain chemo medicines. For example, cisplatin, carboplatin, and some other medicines can cause nerve damage (neuropathy). This can lead to pain, tingling, and numbness in your hands and feet. 

Working with your healthcare provider

It's important to know which medicines you're taking. Write your medicines down, and ask your healthcare team how they work and what side effects they might have.

Talk with your healthcare providers about what signs to look for and when to call them. For example, chemo can make you more likely to get infections. Make sure you know what number to call with questions. Is there a different number for evenings and weekends?

It may be helpful to keep a diary of your side effects. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.